Blessing or curse? Neurocognitive enhancement by "brain engineering"

Purpose Since the 1980s we have witnessed a soaring "extra-therapeutic" use of psycho-pharmacology. But there is also an increasing interest in invasive methods of neuroenhancement that can be subsumed under the term "brain engineering". The present article aims to identify key issues raised by those forms of neuro-technical enhancement (e.g., deep brain stimulation, brain-computer interfaces, memory chips, neurobionic interventions). First it distinguishes different forms of neuroenhancement, then describes features of those methods and finally discusses their ethical implications. Methods The article is based on an in-depth literature study and an ethical assessment of the current and emerging forms of neuroenhancement. Results From a medical and normative perspective, psycho-pharmacological enhancement and nonpharmacological enhancement by brain engineering demonstrate considerable differences. Many arguments in favour of nonpharmacological enhancement fall short, for they fail to sufficiently consider the medical, anthropological and socio-cultural context. In many respects unsecured use is confronted with considerable risks. Conclusions Research on invasive forms of neuroenhancement partly takes place in the fields of (nano-)technology and military, to which health care experts and medical ethicists do not have easy access. This raises the danger of misjudging trends and developmental tendencies. Thus medicine and medical ethics must a priori thematize the goals and risks linked to these questions as well as participate discursively right from the beginning. © Springer Science+Business Media B.V. 2009.